ControversiesinContraceptionTheEvidencetoDecrease.pptVIP

?  Women’s Health in Primary Care Orlando, Florida March 16, 2011 Norma Jo Waxman MD Assoc Professor of Family and Community Medicine University of California San Francisco njwaxman@ Disclosures Norma Jo Waxman MD No pharmaceutical support or other commercial disclosures Objectives: After this talk you will be able to: Describe why pelvic exams and lab tests are not necessary prior to prescribing hormonal contraception. Integrate the use of the Quick Start method of initiating contraception into their practice. Encourage more efficacious and long-acting methods of contraception  Update practice protocols to increase contraceptive use and decrease unintended pregnancy in their office. Outline Unintended pregnancy Barriers to contraceptive access and use Contraceptive methods updates Continuous cycle combined hormonal Evidence based IUD use New Progestin Implant New Sterilization techniques 6.3 Million Pregnancies in the U.S. Half of women at risk are not fully protected from unintended pregnancy The Profound Impacts of Unintended Pregnancy Increased domestic violence1 Increased maternal drug and alcohol use Among teens: Decreased high school completion Increased likelihood of life in poverty The Profound Impacts of Unintended Pregnancy Delayed prenatal care Higher rates of fetal drug and alcohol exposure Higher rates of low birth weight and infant mortality Higher rates of developmental deficits Higher rates of child abuse and life in poverty Jane 27 year-old taking combined OCPS Missed two periods Urine Hcg is positive Jane tells you that she ran out of birth control pills last month, and that she tried to call the office to get an appointment, but the receptionist told her she was overdue for a pap smear and couldn’t get a refill. Today was the first day she could get an appointment with you. What is required before starting contraception? Pelvic exam Up to date Pap test Breast Exam STI testing Pregnancy test None